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A PRACTICAL THEORY 



^.AND TREATMENT OF 



PULMONARY TUBERCULOSIS. 



BYj 

FRANK S. PARSONS, M. D M 

PHILADELPHIA. 



A PRACTICAL THEORY AND 
TREATMENT OF PULMON- 
ARY TUBERCULOSIS. 



r 

BY FRANK S. PARSONS, M. D., U\^ 

PHILADELPHIA, PA. 
Editor of " The Times and Register." 



U- 



'V 



published by 

The Medical Publishing Co., 

No. 718 Betz Building, Philadelphia, Pa. 



To those physicians whose interest in Pul- 
monary Tuberculosis is paramount and those 
sufferers of this dreaded disease, who desire 
relief and encouragement, this little volume 
is affectionately dedicated. 

718 Betz Building, January 28th, 1895. 



LC Control Number 




tmp96 028683 



INTRODUCTORY. 

Is pulmonary tuberculosis curable? 
Undoubtedly! When? At any time 
before destructive changes have ad- 
vanced to a point beyond which the 
organism is incapable of sustaining 
life; or, before the primary cause of 
such changes in retrograde metamor- 
phosis has become lost in the sec- 
ondary pathological processes, which 
of themselves, would advance the or- 
ganism toward ultimate dissolution. 
Of course, the curability of any dis- 
ease, in a measure, depends upon an 
intimate knowledge of its causation 
and a rectifying of disturbed rela- 
tions, and, in this, the physician must 
have the hearty co-operation of his 
patient. The latter is not always an 
easy matter to bring about in tu- 
berculosis, for persons afflicted with 
this disease are prone to disbelieve 
the diagnosis of the physician, in the 
forlorn hope that he may be mis- 



4 
taken, or that it is quite impossible 
for them to become the victims of so 
dangerous a malady. 

It is not niy idea, in presenting 
this paper before the profession, to 
add to the general confusion, which 
now reigns, regarding tuberculosis; 
nor to attempt to laud any new meth- 
ods above others in vogue; but, I be- 
lieve, a clearer light may be thrown 
upon the etiology and treatment of 
this disease, based upon the suc- 
cesses and failures of the past, and 
the recognition of the primative con- 
dition which leads to the develop- 
ment of pulmonary tubercles. 

Of one thing I am quite confident, 
that is, we may search and search in 
vain for the antidote, or specific 
medication in tuberculosis, unless we 
get off the track of the microbe, and 
develop the cause for the underlying 
condition, upon which the develop- 
ment of all bacteria must depend. 

We should be thankful for the 



6 
work of the bacteriologist; the re- 
searches of this class of men have 
taught us much, although the germ 
has been the uppermost theme, and 
its products of toxines and toxalbu- 
mens, as the misty clouds which ob- 
scure the light of underlying pa- 
thology, have given us doubtful ideas 
regarding the etiology of disease. 
We have lost sight of the chemical 
composition of man, and the fact that 
disease is only a chemical decompo- 
sition, in the universal furor after a 
specific germ, the phenomena of 
which may be observed in various 
media, in and outside the body. We 
have been scientifically brought face 
to face with that ancient but burn- 
ing question as to w 7 hich was first, 
the chicken or the egg? We are con- 
scientiously taught that no disease 
can develop except from its germ, 
and that no germ can develop except 
from its disease. 

In view of the many vaunted 
methods of treatment in cases of pul- 



monary tuberculosis, some of which 
have certain values, others of which 
are worse than useless, we may well 
look deeper into the underlying phe- 
nomena of this disease, and ascer- 
tain, if possible, the primative 
causes, the earlier symptoms, and 
base on them the more radical treat- 
ment. 

In the first place, it is to be borne 
in mind that no two cases of pul- 
monary tuberculosis should receive 
identical treatment, solely because 
they are tubercular cases. Personal 
idiosyncrasies must be taken into ac- 
count, modes and circumstances of 
life, the stage of the disease, and a 
thousand minor details, which the 
well-informed physician considers 
and governs his treatment according 



CONCERNING THE ETIOLOGY OF 
TUBERCULOSIS. 

The developments from the experi- 
mental inoculation of animals with 
cultured tubercle bacilli, during the 
past decade, have gone so far that 
the profession is now beginning to 
see that there is yet considerable to 
be learned concerning the causation 
of tuberculosis. In fact, it has been 
evident for some time that we have 
allowed the bacillus craze to get be- 
yond our better judgment. 

It cannot be denied that the tu- 
bercle bacillus plays an important 
part in the phenomenal expression, 
if not the etiology of tuberculosis, 
but the facts are daily being brought 
to light which tend to prove that the 
bacillus alone, as a causative agent 
in this disease, is as inefficient as a 
grain of wheat is ungerminative 
without sunlight, air and moisture. 

When is considered the impunity 



8 
with which colonies of tubercle ba- 
cilli have been swallowed, we must 
fall back on the certainty of a pre- 
existing condition, which, when pres- 
ent, offers favorable influence for the 
development of the bacilli, and on 
which the latter depend for support; 
or, otherwise, that the bacteria are a 
product of the disease, and causa- 
tive only as they have the power of 
reproducing themselves, and, when 
in great numbers, of acting as for- 
eign bodies. That tubercle bacilli 
reproduce themselves is not doubted, 
but this simple fact does not argue 
anything, as it is no more than does 
the animal kingdom in general. If 
they produce toxalbumens, as is as- 
serted, it may well be asked if any- 
one knows what a toxalbumen is, 
and the exact effect on the human 
organism? This no one knows at 
present, and it is not always appar- 
ent that the term is more than a 
cloak for ignorance, or to cover a 



9 
theory that there must be some toxic 
product from bacteria in the albu- 
minous elements of the blood to 
cause specific disease. For our pur- 
pose, then, the tubercle bacillus, per 
se, can act only as a foreign body. 

If, before the appearance of tu- 
bercle bacilli in this disease, there be 
a condition upon which the causa- 
tion depends (and there seems to be 
no doubt that this is the case) a 
short consideration of the anatomical 
and physiological relations of the cir- 
culation will, I believe, demonstrate 
how such condition may arise, and 
of what it must necessarily consist. 

Hardly an autopsy is made with- 
out it is seen that some time during 
the life of the subject tubercles had 
been present in the lung, or in other 
tissues of the body, which tubercles 
had resolved, or had been discharged. 
We know that to obtain cicatricial 
repair of lung tissue, a suppurative 
process must have coexisted, and 



10 
that suppuration never takes place 
where there is not interference with, 
or stasis of the circulation of a part 
involved. In other words, there is a 
loss of normal correlation between 
the supply of arterial blood, carrying 
oxygen and nutrition to the part, and 
the venous blood, bearing away the 
carbonic acid gas and waste tissue 
elements. The waste is carried by 
the circulation to the several organs 
in the animal economy best calcu- 
lated to excrete it, and the venous 
blood becomes reoxidized in the 
lungs, loosing its carbon dioxide. 

Essentially, then, perfect tissue re- 
pair is one with perfect circulation, 
and, conversely, any stasis to the cir- 
culation prevents perfect repair. Es- 
pecially is, this true of either venous 
or lymphatic stasis. 

Any suppurative action must have 
origin in an obstruction to circula- 
tion in the part affected, and resolu- 
tion occurring during any stage de- 



11 
pends on the re-establishing of nor- 
mal correlation in the entire circula- 
tion of such diseased tissue. Abscess 
formation is nature's way of ridding 
tissues of abnormal waste when the 
circulation is impeded. 

But circulation in the animal sys- 
tem is a complex phenomenon, physi- 
ologically of two kinds, afferent and 
efferent ; anatomically of three kinds, 
arterial, which is superabundantly 
generous for nutrition; venous, 
which is inadequate for the removal 
of all the excess; lymphatic, which 
supplements the office of the veins in 
removing waste. A vigorously act- 
ing lymphatic system precludes dan- 
ger from tissue stasis in rapidly 
wasting parts, while inactivity of the 
system implies obstruction from sta- 
sis. 

This point was admirably illus- 
trated by the eminent oral surgeon, 
Dr. James E. Garretson, several 
years back, in a paper read before 



12 
the Pathological Society of Philadel- 
phia, but which has never been pub- 
lished to my knowledge. The illus- 
tration draws attention to a circle, as 
representing a part, or every part of 
the human body, in the continuous 
process of building and razing. Ma- 
terial is brought to it. Eubbish is 
to be taken away. Debris calls for 
the work of the scavenger acting as 
supernumerary to the removal of 
rubbish. These bringers and takers 
are the arteries, veins and lymphat- 
ics. The first brings material ; brings 
it in excess. The second carries 
away the excess; carries away the 
rubbish as well. The third cleans up 
generally. 

It is this third factor in the circu- 
lation that most concerns us in the 
etiology of tuberculosis, and a brief 
consideration of the functions of the 
lymphatic system will aid in the 
clear understanding of their relation 
to the causation of disease. 



13 

First, inquiry as to the relation of 
the lymphatics with the secretory 
system of glands develops the fact 
that both the conglobate and race- 
mose varieties have identical offices 
of excremental and recremental 
signification. The lymphatic system, 
therefore, must be one whose func- 
tions imply the taking of material 
from a relation with parts that do 
not need it, and placing it in rela- 
tion with parts that do ; i. e., the lym- 
ph atics take care of excess of nutri- 
tious elements and return them to 
the general circulation. 

We may logically distinguish the 
lacteals and lymphatics as belonging 
to different systems. It is true that 
both characters of vessels hold pabu- 
lum, a fact which does not argue 
against the lymphatic as being a sys- 
tem, the office of which is purely 
emunctory; for the pabulum found 
in these vessels, that is not excreta 
in the strict sense, is so in signifi- 



14 
cance, being an excess of nutritional 
material which would speedily as- 
sume the form of an irritant were it 
not removed to a new situation; as 
implied in its restoration to the gen- 
eral circulation. 

The lymphatic system, then, ex- 
cluded from the lacteals, being ac- 
cepted as primal emunctory organs, 
it must follow that glands like the 
pancreas, liver, kidneys, etc., must be 
considered as secondary, or excre- 
mental emunctories. 

Bile, urine, perspiration and the 
secretion of all the other excrementi- 
tial glands (as physiological meaning 
is given the word excrement) are phe- 
nomena of the blood, and are de- 
pendent on tissue metamorphoses. 
Tissue metamorphoses ceasing, sec- 
ondary secretion ceases also, and 
death ensues. Tissue metamorphoses 
ceases to be physiological in propor- 
tion as the lymphatic system be- 
comes pathological; that is, tissue 



15 

metamorphoses is not an act in rela- 
tion with racemose glands. 

Reverting to our first corollary, 
that perfect tissue repair is one with 
perfect circulation, it is now seen 
that perfect health is identical with 
perfect excretory function, or, in 
other words, with perfect elimina- 
tion. 

Again, considering our converse 
proposition, we may now also see 
how default in lymphatic action is 
the starting point out of which may 
arise many phenomena of disease. 

The pathological phenomena of 
tubercle, relating to the gray or 
granular and the yellow or caseous 
matter, is familiar to all; but what 
is tubercle, and whence does it come? 

It is to be argued that primarily 
tubercle is a thing having no objec- 
tive nature, in the sense that the 
poison of a rattlesnake, introduced 
through a bite to the system, is a 
thing possessed of objectivity. 



16 
Neither can it be similarly said of 
the tubercle bacillus. Tubercle, if not 
objective, must be a subjective condi- 
tion, the subjective lying primarily 
with a perversion of the lymphatic 
system. 

The acceptance of these last two 
propositions brings us to another 
corollary, viz., tuberculosis is not a 
disease, but a symptom — a symptom 
of lymphatic disturbance or stasis. 

For the proving of the above prop- 
osition let us consider scrofulosis, 
struma and lymphoma. 

I am aware that there are those 
who refuse to believe scrofulosis to 
be identical with tuberculosis, but 
that they draw the line of demarka- 
tion too finely, and that both terms 
are synonymous with the same condi- 
tion I trust we shall see hereafter. 

Scrofulosis, all will agree, divides 
its expression into two forms — surg- 
ical and medical — or lymphoma and 
struma. By the term lymphoma is 



17 
meant a tumor of a lymphatic gland, 
hypertrophied by reason of interfer- 
ence with its efferent circulation. All 
such tumors sooner or later express 
interference with lymphatic circula- 
tion by the effusion of lymph into the 
surrounding tissues. A lymphoma is 
scrofula localized. Struma implies 
torpidity of the lymphatic circula- 
tion at large, and is scrofula gener- 
alized. 

A scrofulous patient is full of ob- 
structions. Abscess is nature's 
method of clearing up such obstruc- 
tions. The obstructions exist because 
there is no capable lymphatic sys- 
tem to remove them. Lymphatic ab- 
scess is a symptom of struma. 

Tubercle is first met with where 
lymphoma or lymphangitis has alter- 
ed the correlative relations of the 
lymphatic system, and its meaning is 
that obstruction exists. Tubercle is, 
therefore, dependent on lymphatic 
stasis, for without such we never get 



18 
tubercle. Tubercle is a symptom of 
tuberculosis. 

It will now, I trust, become evi- 
dent why scrofulosis and tuberculo- 
sis are identical. They are both 
symptoms of the same lymphatic con- 
dition. 

Eeference to the anatomy of the 
lymphatic system, as this is of rela- 
tion to the lungs, shows the former 
to be delicate in character and much 
exposed. Beginning with the ter- 
minal radicals, the lymphatics ac- 
company the blood vessels until ter- 
minating in the bronchial glands at 
the root of the lung ; the efferent ves- 
sels from the latter traverse the 
tracheal and esophageal glands be- 
fore emptying themselves into the 
general circulation. The bronchial 
glands are in " state of change from 
youth to old age, consequently are in 
a state of susceptibility. Calcareous 
degeneration is not uncommon in 
them. Obstruction in a bronchial 



19 
lymphatic implies obstruction in lung 
metamorphoses. Here, then, we ar- 
rive at the point of scrofulosis pro- 
ductive of tubercle; whether the pro- 
duction shall be caseous or miliary 
may be assumed to depend on the 
catalytic influences as excited on 
epithelial or on alveolar structures, 
or possibly on the state of the sys- 
tem at large. 

Pulmonary tuberculosis arising 
from "taking cold 77 is primarily a 
pure local affection. If too wide an 
area of lymphatics are not involved 
cure will come with suppuration, as 
evidenced by the cicatricial repair 
found in autopsies, before mentioned. 

Struma, associated with general 
lymphatic derangement, is phthisis 
expending itself in the lung, and is 
formidable in proportion to the de- 
rangement. Struma, it will be re- 
membered, is referred to as scrofula 
generalized, in distinction from lym- 
phoma, or scrofula localized, both 



20 
being dependent on more or less 
lymphatic stasis. 

Recalling the pathology of chronic 
inflammations in general, it will be 
remembered that there exists a con- 
tinued stagnation of lymph and 
blood, as well as coagulation in their 
vessels, and a condition of hyper- 
plasia is first induced in the walls 
of these vessels, and then in the im- 
mediately surrounding parts. The 
process being a continued one must 
be gradual, for by a sudden and 
complete stagnation we get active 
or acute inflammation, and not 
chronic. 

What, then, is the cause of lym- 
phatic stasis, leading to a condition 
which may result in tuberculosis? 

We koow that an irritation acutely 
expressed, as in the case of burns, 
induces active inflammation. We 
also know that irritation of a mild 
degree, applied continuously, induces 
chronic inflammation, as in the case 



21 
of gastric catarrh from the alco- 
holic habit. We have seen how ir- 
ritation, increasing the flow of blood 
to a part, tends to produce hyper- 
trophy of that part ; yet, that so long 
as the efferent vessels carry off the 
additional waste there is no ten- 
dency to ulceration or retrogade tis- 
sue metamorphoses, other than that 
induced by the contraction of new 
tissue formation, and the secondary 
cutting off the blood supply. But as 
soon as the correlation between the 
efferent and afferent vessels becomes 
interfered with, and the waste pro- 
ducts are left in the part, ulcerative 
and suppurative changes take place. 
(This is evidenced in malignant tu- 
mors also.) 

But, the question whether these 
chronic inflammations are always 
induced by irritations, and by what 
such irritations are caused, is still 
speculative. 

Obviously, lymphatic stasis is the 



22 
result of obstruction to lymphatic 
circulation. Whether this obstruc- 
tion exists in a coagulation induced 
by foreign bodies, or by an interfer- 
ence with the normal tone or healthy 
condition of the arterial blood sup- 
ply (probably due to a deficiency in 
oxygen or an oxidizable element, or 
an increase in the noxious gases of 
the blood) and, hence, increasing the 
amount of waste to be carried off 
by the lymphatics, thus producing 
sluggishness in their circulation, is, 
of course, an open question. 

One thing is certain — that is 
the irritation, if such there be, 
must be applied continuously to a 
point where the lymphatic stasis is 
complete enough to cause, of itself, 
the remaining pathological tissue 
changes in the disease. This must 
occupy a considerable period of time, 
and it is not apparent how a multi- 
tude of bacilli, simply as foreign 
bodies, can remain in any spot of the 



23 
rapidly-moving blood current long 
enough to irritate and thereby pro- 
duce such coagulation, or stasis, in 
an open lymphatic system of vessels. 
Bacilli, entering the blood current, 
must encounter difficulty of develop- 
ment except when at rest, or the 
oxygen is limited below the normal, 
and any such rest of the blood cur- 
rent would imply stasis somewhere 
in the lymphatics. 

It may be well to pause here to 
consider the germ theory as relat- 
ing to the production of tuberculo- 
sis. 

From all that has been demon- 
strated on the living human organ- 
ism, germs appear to belong to two 
great classes: 

First, those that are said to pro- 
duce acute diseases. 

Second, those that are said to pro- 
duce chronic diseases. 

This division, which is here drawn 
for convenience, is apparently one 



24 
of intensity of virulence, the former 
being active and extremely poison- 
ous, but easily destroyed, the lat- 
ter being less active, but of greater 
tenacity to life. The former may be 
illustrated by the Klebs-Loeffler ba- 
cillus of diphtheria, and the latter 
by the Koch bacillus* of tuberculo- 
sis. 

It has been demonstrated that 
these germs will reproduce them- 

*(The products of bacilli, the toxalbu- 
mens, toxines, etc., which are said to be 
the ptomaines of disease, are duly con- 
sidered in their connection with this 
subject; but it is difficult for the writer 
to understand how a poison, if such 
exist to cause disease can be found 
prior to the development of the bacillus, 
which is said to be the father of the 
poison; the poison certainly does not pro- 
duce the bacillus; moreover, it is a pret- 
ty well established fact that symptoms 
of tuberculosis, or indications leading 
thereto, are more or less advanced be^ 
fore the appearance of the tubercle bacil- 
lus is demonstrable, or enters into the 
symptomatology.) 



25 
selves in favorable media outside the 
body, and, when injected into the 
blood of susceptible animals, will — 
what? — produce their specific dis- 
ease? — no! — reproduce themselves. 

If one examine the carcase of a 
dead dog, or other animal, it will be 
seen that the body is full of living 
organisms, which, moreover, are not 
all of the same kind. It is also of 
common observation that these or- 
ganisms are to be found occasion- 
ally on living animals, including the 
human species, who may be the sub- 
jects of suppurative lesions. They 
are found where decomposition is 
going on in some form. They feed 
on dead tissue and not on the living. 
So it is with bacteria. They are to 
be found in the waste products of 
the body. They are not able to sub- 
sist on healthy living tissues or cells, 
as evidenced by their destruction in 
them. Where suppuration and de- 
cay exist there will be found the 



26 
bacillus. If it is one of the virulent 
kind found in diphtheria, it may in- 
habit the waste products of every 
throat irritated by a "cold," or every 
open sore or wound it comes in con- 
tact with, and may intensify the in- 
flammatory action by its irritative 
presence. It reproduces nothing but 
its kind, and it seems probable that 
the determining factor of its viru- 
lence is the rapidity of its reproduc- 
tion. The healthy throat is so rare, 
especially in children, that the field 
is ample for its generative powers. 
The above is as true of other germs, 
including the tubercle bacillus. They 
reproduce themselves in favorable 
media and atmospheric conditions, 
and are destroyed by unfavorable 
conditions. 

The experiments conducted on 
Guinea-pigs and rabbits with cultur- 
ed tubercle bacilli, to show that 
Koch's germ induces tuberculosis, do 
not prove of much value, inasmuch 



27 

as these animal- ery prom 

•reular processes from any sort 
of irritative interference with their 
lymphatic circulation, and especially 

so v ich irritation is app] 

to a membrane, as the [ 

toneum. 

It must be rationally argued that 
the favorable medium for one kind 
of bacillus may not be identical with 
that example: Ii 

waste elements in t 1 serum 

from eh . alti- 

vation ground for th . .le bacil- 

lus, it A arily imply 

that the 

ble field for the cultivation of the 
Kiel and vice 

versa. Hence, various forms of germs 
may appear in different diseases, not 
because the germs are specific, ex- 
: as diagnostic phenomena, but 
because they develop and multiply 
in different media. It is not every 
sore, or diphtheritic throat that 



28 
gives evidence of a Klebs-Loeffier 
bacillus, nor every healthy throat 
that does not contain more or less of 
them. 

Without doubt, we imbibe, daily, 
germs of many descriptions. We 
breathe them in the air around us, 
and swallow them in the food we eat 
and the water we drink. So long as 
our excrementitial organs and the 
lymphatics are ill a healthy condi- 
tion there can be no spot for germs 
to congregate and multiply in the 
blood. Most of them are destroyed 
by oxygen, and none can germinate 
in the blood current when oxygen is 
in its normal quantity or in excess. 
This is evidenced by the results upon 
consumptives of living in ozonized 
atmospheres and high altitudes. 
Oxygen is the best sterilizer of 
which we know. Germs, alive or 
dead, will pass out with the waste 
products of the body if not hindered, 
by a stasis in some excrementitial 
organ. 



29 

Returning to our consideration of 
lymphatic stasis, we may assume 
that a cause for lymphatic obstruc- 
tion may be found in an incompetent 
excrementory organ, which theory is 
perfectly in accord with the acknowl- 
edgment of the lympathic organ of 
tuberculosis. Such organ may be the 
seat of congenital or acquired incom- 
petency. 

Congenital incompetency may be 
due to a faulty intra-uterine nutri- 
tion, tending to dwarf the organ and 
limit its function; or such incompe- 
tency may result from some one of 
the many unknown causes common 
to other congenital deformities. 

Acquired incompetency must de- 
pend on faulty nutrition after birth ; 
this, without doubt, is due to a lower 
degree of oxidation in the cellular 
elements of the blood. Whether such 
lowering of oxidizing power be in 
consequence of a deficiency of oxi- 
dizing agents, according to Church- 



30 
ill's theory, or the outcome of loss in 
the available oxygen to vitalize the 
tissues, the result is the same ; i. e., 
sluggishness of the efferent circula- 
tion by overcharging the lym- 
phatics and veins with waste tissue 
elements, the ultimate backing up 
of waste products in the capillaries 
of the affected part, and, finally, 
stasis resulting in inflammation, 
which will be acute or chronic as the 
completeness of the obstruction be 
accomplished suddenly or gradually. 
It is on complete oxidation that 
the healthy cellular life of the ani- 
mal depends. Deoxidation means 
death. Life is opposed to death, and 
nature is continually striving to pre- 
serve the former by ridding herself 
of the latter. As soon as an animal 
cell is deoxidized it becomes devital- 
ized and is crowded out of its rela- 
tions with living cells. If it can pass 
out through the excrementory chan- 
nels, as nature intended it should, 



31 
no harm will result, even if many 
bacteria are feasting on the defunct 
cell. If it cannot pass out, but is 
held by stasis or obstruction in rela- 
tion with living cells of the part, 
we soon have a collection of such 
dead material causing irritation to 
the nerve elements* of surrounding 
tissue, and inflammatory results. 

Deoxidation or other alterations 
in the chemical equilibrium of the 
normal human organism may be 

*I incline to the opinion that we have, 
first, a stasis of waste elements; sec- 
ond, a nerve cell paralysis due to the 
stasis; third, increased blood supply to 
the part as a result of the paralysis 
and which, owing to the existing ob 
struction, brings about the phenomenon- 
inflammation. Phagocytosis may be 
easily explained, inasmuch as a leuco 
cyte, if it does not contain enough oxy- 
gen to vitalize it, becomes pus, and, 
hence, waste; if there is oxygen 
enough in the cell bacteria may be 
destroyed; otherwise, as a waste cell 
it may become the prey of the microbe. 



32 
brought about in many ways. It 
would be interesting, in this connec- 
tion, to note what the different ef- 
fects are from atmospheric changes 
upon the chemistry of the blood. 
Different localities and seasons must 
have noxious chemical elements, 
which are detrimental to certain hu- 
man organisms whose excrementitial 
powers are below the normal. There 
is no reason to suppose that chemi- 
cal elements act differently than 
their natures, which are known spe- 
cifically in the laboratory, determine 
that they must. Why, then, cannot 
gases in the air act chemically on 
the gases of the blood to produce dis- 
ease, and this irrespective of any 
germ? 

It seems nonsensical to assume 
that a micrococcus alone should hare 
the power of limiting a disease like 
pneumonia to a solitary lobe of a 
lung. If microbes play a primary 
part in the etiology of disease 



33 
through the medium of the blood, 
why do they not occasion uniform 
inflammations in the various organs 
or parts of the body and not con- 
fine themselves to specific spots, as 
they are said to do in pneumonia or 
diphtheria? Blood serum, if it is a 
developing medium anywhere, must 
be so throughout the entire body. 

It is a fact that in phthisis, or 
tuberculosis, the venous blood is 
brighter than normal. This gives 
evidence that the oxygen imbibed 
by the red blood-corpuscles, in the 
lungs, is not properly oxidized in 
the tissues, and passes over through 
the capillaries in a free state. This 
fact would imply that there was a 
deficiency in an oxidizing element. 
We know that the blood contains 
phosphorus in an oxidizable form, 
and that oxygen has a great chemi- 
cal affinity for phosphorus; hence, it 
is not out of reason to infer that in 
the condition known as tuberculosis 



84 
there is a deficiency in oxidizable 
phosphorus. This fact is proven by 
the supplying to the blood of a 
phthisical person an oxidizable form 
of phosphorus, when it will be seen 
that the venous blood assumes its 
naturally darkened hue. 

We know that every effort, men- 
tal or physical, oxidizes this element 
in the organism into phospate, a 
waste product, and that there is also 
direct connection between the ex- 
cretion of the phosphates and the 
waste of nervous element. The abun- 
dance of means for causing an ex- 
cess of oxidizable phosphorus to be- 
come a waste product in the shape 
of the phosphates gives ample op- 
portunity for a condition of devital- 
ization. This element may not be 
the only chemical agent in tubercu- 
losis, but that it is a very important 
one is evidenced by the results of ' 
treatment along this line. 

The question whether pulmonary 



35 
tuberculosis may be communicated 
by contagion, or infection, does not 
rest with the proving that a specific 
germ is found in this disease, for we 
know that unless a favorable me- 
dium is presented such germ will 
not develop, and that to obtain this 
medium there must be a condition 
to be recognized as pathological. If 
an element of infection exist in any 
locality, and we take for a criterion 
the fact that ozonized atmospheres 
are exempt from tuberculous cases 
developing in them, then it holds 
that there must be a proportionate 
deficiency in oxygen in those locali- 
ties in which tuberculosis is develop- 
ed. Ozonized atmospheres are both 
beneficial to the oxidation of the 
blood and the destroying of micro- 
organisms. Living in localities 
where there is a tendency to defi- 
cient oxidation of the tissues will, as 
a consequence, tend to increase 
waste elements; which, if there be 



36 
an incapacitated lymphatic system 
to carry such waste away from situ- 
ations where they will do harm (as 
might follow a pneumonia, laryn- 
gitis, or other acute inflammation of 
the respiratory tract), may cause the 
starting point of tuberculosis. 
Bacilli may be communicated if 
there is found favorable lodging for 
their development. 

The conclusions regarding the eti- 
ology of pulmonary tuberculosis 
which the writer has endeavored to 
show may be summed as follows : 

That pulmonary tuberculosis is 
due, primarily, to a lymphatic stasis. 

That such lymphatic stasis may be 
congenital, or acquired, as a result 
of incompetency of excrementory 
function. That incompetency of ex- 
crementory function may be develop- 
ed from acute diseases, especially of 
the respiratory organs, or from grad- 
ually increasing stasis of waste ma- 
terial due to overtaxation of excre- 



37 
mentory organs (where such, can be 
overtaxed), by deoxidation of the tis- 
sues. 

That the tubercle bacillus is to be 
regarded as a development, existing 
simply because favorable media are 
presented, in the lymphatic stasis, 
for its cultivation. The develop- 
ment is often some length of time 
after the stasis is apparent, and in 
some favorable cases may not de- 
velop at all. Bacilli may exert in- 
fluence on the disease as foreign 
bodies, similar to other foreign or 
waste elements; but are not, pri- 
marily, causative. They form excel- 
lent symptoms of tuberculosis if they 
develop early enough, but the mere 
removal of them will not cure the 
disease, unless such removal implies 
restored excrementitial function and 
perfect lymphatic circulation and 
elimination. 

That tuberculosis implies the 
atrophy of the pancreatic gland in 



38 
the majority of cases, but that the 
dislike of fats by phthisical persons, 
or those having a consumptive ten- 
dency, is the only symptom we can 
depend upon to show that in the 
pancreas may lie the origin of this 
disease. 

CONCERNING THE EARLY SYMP- 
TOMS OF PULMONARY TU- 
BERCULOSIS. 

The ordinary symptoms of tuber- 
culosis of the lungs are so familiar 
to physicians at large as not to need 
consideration in a paper of this char- 
acter. There is, however, one symp- 
tom that presents and accompanies 
all others, and which, strange to 
say, has been entirely overlooked, so 
far as the writer knows, until at- 
tention wa« directed to it by Pro- 
fessor Garretson, in his clinical lec- 
tures. This refers to a dislike of 
fats by people having the phthisical 



39 
tendency. Observation will show 
that fat-eaters are almost entirely 
exempt from the disease we now con- 
sider; while, on the other hand, the 
information that the appetite and 
stomach of a patient refuse fats is to 
be accepted as diagnostic of the con- 
dition established, or of dangerous 
and formidable tendency to it. 

The universality of this dislike and 
refusal of fats by the destined vic- 
tims of phthisis commands for the 
peculiarity the first place in a con- 
sideration of symptoms. 

To what is to be referred the dis- 
like and refusal? 

It is a deduction by Dr. Garretson 
that the pancreas is at fault in all 
such persons; and that with this 
gland is not unlikely to be found the 
origin of all those cases of gradually 
developing consumption which con- 
stitutes the large majority. The 
writer has fully satisfied himself, out 
of sufficient data, that too much im- 



40 
portance cannot be made of this 
symptom; for, with its early recog- 
nition, before destructive changes 
have taken place, we have our great- 
est hopes for successful treatment. 

The symptom indicates that there 
is either faulty secretion from the 
pancreas, whose function is to fur- 
nish a chemical product for the 
emulsification of fats; or a chemical 
inferiority of the secretion, by reason 
of impaired nutrition; otherwise an 
inability on the part of the lacteals 
to properly absorb the emulsion. 

The first could easily exist in a 
congenital abnormality of the pan- 
creas. The last would exist in in- 
testinal catarrh. 

Another important early symptom, 
though not pathognomonic, but sug- 
gestive, lies in the abnormal weak- 
ness generally observed in consump- 
tives. This languor is undoubtedly 
due to the deficiency in oxidizable 
phosphorus and the increase in 



41 
waste phosphates, dependent on 
retrograde tissue metamorphoses. 
It is in this manner that the vitaliza- 
tion of the tissues is impaired, and 
weakness is a symptomatic result. 
Too often this symptom is passed 
over by the physician as an indica- 
tion of "malaria." 

Limited lung and chest expansion, 
while not essentially an early symp- 
tom of phthisis, when it exists is 
very suggestive, and demands thera- 
peutic attention. 

Another of the early symptoms, 
which has important bearing on the 
therapy of tuberculosis, is chronic 
gastric catarrh. More strictly class- 
ified, it is a complication, as it is to 
be regarded as a result of the general 
systemic disturbance rather than a 
tubercular lesion of the stomach. 

Other physical signs of phthisis 
are of great importance. Mention 
of some of them may not be out of 
place. The signs belonging to the 



42 
incipient stage are slight dullness 
on percussion, broncho-vesicular res- 
piration, or a weakened respiratory 
murmur, more or less frequency in 
respiration, some increase in the 
vocal resonance, increased bronchial 
whisper occasional subcrepitant 
rales, pleuretic friction murmur, and 
abnormal transmission of the heart 
sounds. Most of these signs are lim- 
ited to the summit of the chest on 
one side. As the case advances the 
physical signs are intensified and 
augmented. Pectoriloquy may be 
present before and after the forma- 
tion of cavities. In the former in- 
stance the transmission of speech is 
by solidified lung; in the latter, it 
occurs through a cavity. Cavernous 
sounds accompany the formation of 
cavities only. 

Hemoptysis is likely to happen 
early in the disease, in the majority 
of cases; and, if before cavity forma- 
tion, it is to be regarded as indica- 



43 
tive of congestion and rupture of 
the smaller bronchial vessels. After 
cavities have formed, bleeding may 
originate from their walls. Occa- 
sionally, in the latter instance, a 
large vessel may be opened, causing 
fatal hemorrhage. 

If the larynx be involved, huski- 
ness or hoarseness of voice exists. 
Occasionally the voice may be lost 
entirely for a space of time. 

Kise in temperature is an early 
sign, and one apt to be attributed 
to malarial disease on account of 
its - * intermittent quality. 

Anemia and pallor of counte- 
nance are more or less marked from 
the beginning as a result of impover- 
ished blood. 

Tuberculous peritonitis may occur 
as an acute or chronic affection, and 
is to be regarded as symptomatic 
of the pulmonary type only in regard 
to the tendency it exhibits toward 
subsequent involvement of the lym- 



44 
phatic system in the lung. A pecu- 
liar consequenc of treatment is 
the curability of tuberculous peri- 
tonitis by laparotomy. This has 
lately been attributed to the en- 
trance of the staphylococcus through 
the atmospheric air, and the claim 
made that the toxalbumen from 
this micro-organism is antagonistic 
to the tubercle bacillus. If this 
were true, we would have no pul- 
monary tuberculosis; for we are 
breathing into our lungs, daily, sta- 
phylococci enough to generate toxal- 
bumens for a nation; and, if there 
is any such antagonistic action on 
tuberculous products in the peri- 
toneum, why not in the lung? The 
effect of atmospheric air on the 
serous membrane of the peritoneum 
seems to have the effect of restor- 
ing eliminatiye function of the ef- 
ferent vessels; a thing it does not 
establish in the lung. 
Microscopically, a third blood-cor- 



45 
puscle has said to have been demon- 
strated, which is attributed by some 
to be one of the causative factors of 
this disease. It is doubtful if this 
corpuscle be more than an altered 
leucocyte; possibly occurring as 
waste : but not at all causative. It 
remains to be proven whether it be 
symptomatic or not. 

The venous blood of phthisical per- 
sons is brighter than normal, unless 
they are undergoing treatment by 
hypophosphites. 



THE MORTALITY OF TUBERCU- 
LOSIS. 

Evidence is given that the mortal 
ity from this disease is no greater 
at the present day than it was hun- 
dreds of years ago. A recent ar- 
ticle was published in an exchange, 
which I regret having mislaid, show- 
ing that, in Jewish history, years 



46 
before the Christian era, consump- 
tion was as rampant as now. This 
w T ould tend to refute the idea that 
tuberculosis is at present on the in- 
crease, and at the same time indi- 
cate that we possess no better ther- 
apy for this affection now than did 
the ancients. 

The Medical Record published 
some time since an article showing 
the different occupations predispos- 
ing to tuberculosis, and I can do no 
better than to quote the article 
here. 

"The greatest number of deaths 
from phthisis occur in workers ex- 
posed to irritating substances in the 
respired air. In Switzerland 10 out 
of 100 stone cutters die from phthis- 
is. In England of 1000 deaths occur- 
ring in these workers, 340 were from 
phthisis. Tuberculosis makes cruel 
onslaught likewise in those indivi- 
duals who habitually occupy a bent 
posture at their occupations, and in 



47 

those who live sedentary and intel- 
lectual lives. Of 1000 deaths in 
Italy among students and seminar- 
ians 450 died of phthisis — that is, 
nearly one-half. In England, of a 
similar number of deaths in prin- 
ters, 430 died of phthisis.'' 

"On the other hand, statistics 
show that it was quite exceptional 
for this disease to be the cause of 
death of those who live in open air. 
Switzerland, of 1000 deaths occur- 
ring in outdoor laborers and farm- 
ers, not more than one or two die 
from phthisis. A similar number of 
deaths in Italy among shepherds and 
farmers shows only from 44 to 45 
deaths." 

"In France the sanitary statistics 
gathered from 662 towns show that 
the more the poulation is conglom 
erated, so in proportion are the in- 
habitants gravely infected with tub 
erculosis." 



48 



TREATMENT. 



The recognition of lymphatic stasis 
as the primal cause of tuberculosis 
explains the failure to successfully 
combat the disease with antiseptics. 
Germs will develop in a favorable 
medium, and it is impossible to ren- 
der the medium unfavorable in tu- 
berculosis without removal of the 
cause of its presence : i. e., lymphatic 
stasis. We know the effects of urea 
on the human system when it is re- 
tained in the blood by obstruction in 
a diseased kidney. Why, then, 
should the same not hold true in 
relation to waste elements from 
other parts of the body? Eelief and 
cure coming by restoration of elimi- 
native function are proportioned by 
the completeness of the latter. Micro- 
organisms depart when the medium 
in which they thrive is eliminated. 
The only way to sterilize the germ- 
ground of tuberculosis is by remov- 



ing the waste: i. e., increase oxygen 
and the function of oxidation by add- 
ing elements to the blood which 
have a natural affinity for oxygen in 
the organization of healthy tissue. 
In accomplishing this the actual 
waste elements are lessened, giving 
the excreting organs less work to do, 
thereby allowing nature a chance to 
absorb excess and repair damage. 

As most patients come to us in a 
more or less advanced stage of tu- 
berculosis, generally after lesions 
have developed which are demonstra- 
ble by physical examination, we have 
lost the most promising of the peri- 
ods for inaugurating successful treat- 
ment. If, however, the case has not 
advanced to a point where the le- 
sions which are present may not of 
themselves prove destructive to life, 
there is always hope that, with 
proper care and treatment, recovery 
may ensue. 

In a paper like the present it is 



50 
difficult to map out the proper treat- 
ment for all cases of phthisis. If 
there is a disease in the category of 
chronic affections which in its treat- 
ment requires wisdom, skill and 
judgment, that disease is pulmonary 
tuberculosis. 

The first thing to do is to study 
the individual case. Temperament, 
environment and the circumstances 
of a patient have much to do with 
success in treatment. If a different 
climate is required and the financial 
means to carry out such requirement 
is lacking, the chances are so much 
less in a patient's favor. (This is not 
saying that every patient needs 
change of abode.) 

In nearly every case, no matter at 
what stage of the disease, it is hope- 
less to attempt medication without 
first preparing the stomach and in- 
testines to favor absorption of the 
remedies used. These organs, where 
phthisis is present, are usually in a 



51 
state of chronic catarrhal inflamma- 
tion, with more or less thickening of 
the mucous membrane, thereby ren- 
dering digestion and absorption in- 
efficient. 

To begin with, it is found of ad- 
vantage to insert a stomach tube 
and thoroughly wash out that organ, 
teaching the patient the art of per- 
forming the feat himself. The solu- 
tion used for this lavage should be 
a one to 16 dilution of Marchand's 
hydrozone in warm water. I prefer 
the hydrozone to the peroxide of hy- 
drogen, because it is double the 
strength of the latter * and is more 
constant in its therapeutic qualities. 
The solution should be allowed to 
remain for a few minutes in - the 
stomach and then be syphoned out 
through the tube. 

Peroxide of hydrogen or hydrozone 
acts in two ways on the mucous 

* See "Times and Register," Decem- 
ber 15, 1894. 



52 
membrane of a stomach chronically 
inflamed. First, it clears the sur- 
face of excess of mucus, combining 
with the pus to form carbon diox- 
ide and nascent oxygen (both gases 
and easily removed through the 
tube); second, the oxygen of the 
preparation acts directly and favor- 
ably in stimulating the mucous mem- 
brane and underlying glands, there- 
by favoring the circulation of blood 
and the performance of function. 
The good results of lavage of the 
stomach will be apparent in a short 
time by an increasing appetite, with 
better assimilation of food. 

Second to this method, for the 
treatment of catarrh of the stomach 
in tuberculosis, is internal adminis- 
tration of hydrozone before meals. A 
dilution of one part hydrozone to 32 
of water may be employed in this 
manner; a glassful of the mixture tak- 
en half an hour before meals. If the 
dilution is too strong the gas gene- 



53 
rated will be distressing to the pa- 
tient. Glycozone (c. p. glycerine 
treated to 15 times its own volume 
of ozone) may be used together with 
the hydrozone as a curative agent. 

The building up of the body by nu- 
tritious and well-assimilated food is 
a primal necessity in treating tuber- 
culosis. The disease being one of 
impaired nutrition, it is obvious that 
waste of the body must be reduced 
to the minimum, in order to prevent 
further lymphatic stasis from excess 
of excreta. 

On the other hand, the production 
of tissue-forming elements in the 
blood must be encouraged. Oxygen 
is not only to be carried into the tis- 
sues, but utilized there. Oxidation 
is essential to cell ife. 

The foods necessary to the forma- 
tion of tissue may be classified as 
natural and chemical, or therapeuti- 
cal (all being essentially chemical). 

By the term natural food is here 



54 

intended such articles of diet as, by 
process of digestion, are converted 
into pabulum from the ordinary ta- 
ble supplies.in contra-distinction from 
chemical food medicinally employed. 

To the former class belong animal 
and vegetable foods and oil; to the 
latter the hypophosphites. iron, lime 
and soda. 

Discussion of diet and phthisis has 
been elaborated in so many mono- 
graphs on the subject of feeding that 
only such articles will be mentioned 
here as pertain to the therapy of the 
disease. 

A nitrogenous diet is essential, but 
care must be taken not to over- 
supply it, for the reason that a too 
highly nitrog^nized diet i animal food] 
throws upon the system excess of 
eliminative work. All nitrogenous 
matter, which is in excess of that di- 
rectly applied to growth and recon- 
struction of the body, undergoes a 
process of retrograde metamorphosis, 



55 

taxing the excrenientitial organs, and 
cannot fail to do harm. Where ex- 
ercise and free circulation can be 
maintained nitrogenous elements are 
best borne. 

It devolves upon the physician to 
point out suitable foods to be taken, 
but it depends upon the system of 
his patient whether his recommenda- 
tions can be carried out. It is not 
good to force any rigid dietetic regu- 
lations, founded upon the number of 
grains of carbon and nitrogen neces- 
sary to support life, as may be done 
in health. 

If we consider force production, re- 
sulting from different articles of 
food, it will show that fats, especially 
cod liver oil and olive oil, lead the list 
in value. The inability of phthisical 
persons to eat fat is a serious draw- 
back to its use as a therapeutic food. 
Where chronic impairment of power 
exists in the digestive organs it is 
not always wise to force an article 



56 

of food against the appetite and de- 
sires of the patient. Fatty foods 
pass the stomach to undergo emulsi- 
fication, or preparation for absorp- 
tion, in the small intestines. When 
fats are fresh, and not taken in ex- 
cess, they may pass on without giv- 
ing any sign of nausea or sickness of 
the stomach. It is important, there- 
fore, that small doses of oil be given 
in this disease to begin with, and an 
increase be made gradually. Olive 
oil is often better borne by the stom- 
ach than cod liver oil. Petroleum 
oils also have value. The stomach 
and intestines, being in a catarrhal 
state, are not calculated to assimi- 
late fats for proper absorption by 
the lacteals, when given in excess, 
or even the ordinary dose, often in- 
crease the waste to be eliminated 
by their production of volatile fatty 
acids and excite derangement. 

Having first treated the stomach in 
the way suggested, we are prepared 



57 
to apply fats with greater hopes of 
beneficial results. Regarding the 
various emulsions of cod liver oil and 
other oily preparations on the mar- 
ket, it may be said that all pre-einul- 
sified fats have preference to the 
crude oils, providing they contain 
enough of the fatty elements for tis- 
sue building. Oil treated with hy- 
drogen makes an excellent prepara- 
tion of value in certain cases. 

Next to oil in the dietetic manage- 
ment of tuberculosis is beef. What 
is necessary in the administration of 
beef elements to a consumptive is 
not to get the greatest amount into 
him, but to have what he does take 
advantageous to him. Over-charg- 
ing the blood with tissue-forming ele- 
ments means overcrowding the elimi- 
nitive organs, and these are to be 
freed from an excess of pabulum, as 
we shall see when speaking of med- 
icinal therapy. It is not necessary 
to discuss here the different values 



58 
of beef preparations in detail; but 
one method of application of this 
food may be mentioned, because it 
is found of more worth than the ordi- 
nary market products. I refer to 
blood taken from living animals. This 
food, representing the elementary vi- 
talizing fluid, is an ideal tissue-build- 
er. In disease we must consider the 
chemical alterations dependent apon 
an existing malady, and govern our 
therapy accordingly. Healthy living 
blood cells can supply to a wasted 
part, in union with oxygen, recon- 
structive material. Such food to be 
palatable must be perfectly kept, and 
adapted for internal use. The best 
preparation of this kind is repre- 
sented by bovinine, which is simply 
beef blood, drawn from the living ani- 
mal and hermetically sealed, acting 
quite as beneficially as transfusion, 
and with less danger. Beef extracts 
have certain values, but are not in 
the same category with the above. 



59 

A new product has recently been 
brought to the attention of the pro- 
fession from Germany. It is a con- 
centrated alburnose, consisting of the 
active nourishing elements of meat, 
called somatose. It is said to con- 
tain eight times the strength of beef 
and to be readily digested, an import- 
ant point in the treatment of all 
wasting diseases. 

Milk is an article of diet which in- 
cludes the fats without taxing the 
digestive powers. It is commonly 
best borne by being boiled. The ad- 
dition of soda water (aerated water) 
will make it more palatable to those 
phthisical persons who do not like 
milk. Hot milk is an excellent rem- 
edy in paroxysms of coughing, espe- 
cially during the night, with scanty 
or thickened expectoration met in 
the later stages of this disease. In 
this connection are to be considered 
the various milk preparations as be- 
ing of more or less value. 



60 

Where there is much fever in pul- 
monary tuberculosis the carbohy- 
drates are the foods to be most de- 
pended upon; they do not call for 
the excessive eliminative work of the 
nitrogenous compounds, and are eas- 
ily assimilated by the digestive or- 
gans. 

Chemical foods being here con- 
sidered, those elements which are 
necessary to replace the inorganic in- 
gredients of the blood may be repre- 
sented by the hypophosphites, iron, 
lime and soda. 

We have seen why the venous 
blood of a phthisical person is bright- 
er than normal, inasmuch as there is 
a loss of oxidizing element (i. e., oxi- 
dizable phosphorus) and a carrying 
over of oxygen in the free state 
through the capillaries; hence it is 
necessary to supply this loss to the 
blood. This subject has been so 
thoroughly demonstrated by Dr. 
Churchill, of Paris, in his treatise 



61 
on the hypophosphites in phthisis, 
and so well elaborated by R. W. 
Gardner, of New York, that it 
seems unnecessary to enter into de- 
tail on this treatment. A few points 
may be well quoted here, however, 
for the purpose of cautioning the pro- 
fession against the misuse of Dr. 
Churchiirs ideas. First, "the hypo- 
phosphites of soda, lime and quinia 
are the only ones indicated in phthis- 
is." Second, "the hypophosphite must 
be chemically pure and uncombined." 
Third, "the hypophosphite should 
only be in the form of a syrup, be- 
cause this is the only vehicle which 
will protect it from oxidation in the 
air." Fourth, "soda is indicated in 
the incipient stage and lime in the 
second and third stages, with ex- 
ceptions." Lime reduces expectora- 
tion; soda favors it. Judgment in 
using both is necessary. Fifth, "hy- 
pophosphites should not be given 
with any other remedy." Sixth, 



62 
seven grains in 24 hours is given 
as the maximum dose in phthisis. 
Seventh, "plethora must be avoided, 
for it tends to hemorrhage, and, 
hence, cod liver oil, iron and stimu- 
lants, when used, should only fol- 
low the discontinuance of the hypo- 
phosphites." Eighth, "complications 
requiring treatment indicate a dis- 
continuance of the hypophosphites 
while such treatment is being given." 
Iron in phthisis is necessary occa- 
sionally. The anemia of this dis- 
ease being dependent, however, on 
a different cause from those condi- 
tions which bring about anemia 
through faculty correlation of the 
constituents of the red blood corpus- 
cle, as seen in chlorosis", the results 
from iron treatment in phthisis are 
often disappointing. 



63 



CLIMATE. 



Ozone is an indispensable aid to 
the successful treament of pulmon- 
ary tuberculosis. Cities, which have 
been cleared of all forest growth are 
not the ideal locations for the con- 
sumptive to dwell in. Vegetation, in 
healthy and luxurient growth, ab- 
sorbs the carbon dioxide and gives 
out oxygen. Other elements also en- 
ter into the question of climate for 
consumptives, such as dryness of the 
air, altitude and drainage. 

Without entering into a discussion 
of this subject it may here be stated 
that the only way to test a given lo- 
cation recommended a phthisical 
person to reside in, is for such an one 
to try the various localities, if prac- 
ticable, and make a permanent abode 
in the one which agrees best with his 
individual constitution. Colorado, as 



64 

a health resort for consumptives, is 
no place for a victim of the third 
stage of the disease. Fibroid phthisis 
and bronchial irritation, on the other 
hand, do not contraindicate resi- 
dence there. Except in excessively 
high altitudes the liability to hemor- 
rhage is not greater than in other 
localities. 

North Carolina is fast coming to 
the front as a health resort for the 
tuberculous, and properly, too. The 
region in and around Southern Pines 
presents all the advantages of cli- 
matic regularity desirable in any 
stage of the disease. The soil is 
sandy, the air dry, an invigorating 
feeling exists from the ozonized at- 
mosphere, and, being situated in the 
midst of the pine districts of North 
Carolina, there is every element con- 
ducive to health in the locality. 

Southern California has long been 
one of the most famous health re- 
sorts in America. Its balmy atmos- 



6o 

phere, absence of dampness and equ- 
able temperature make it a very de- 
sirable place in which to reside. 
Other localities might be mentioned, 
but of these the writer has personal 
knowledge. 

The application of oxygen inhala- 
tions, while of some value in the 
treatment of phthisis, is by no means 
as satisfactory as the residence in 
ozonized atmospheres — the probable 
reason of this being that oxygen 
given by inhalation through an ap- 
paratus cannot be constantly applied, 
and the good that results, for a few 
hours after this mode of administra- 
tion has been employed, is more than 
counterbalanced by the necessity of 
breathing the normal atmospheric 
air of the locality of residence. In 
other words, the oxygen is not ap- 
plied a sufficient length of time to 
do more than temporary good. Could 
a room be so arranged to furnish the 
patient a continuous ozonized atmos- 



66 

phere the results of the cabnet meth- 
od of treatment might be improved. 

HYGIENE AND EXERCISE. 

Important as are proper diet and 
air for consumptives, no less so are 
regulated exercise and hygiene. It 
is a well-known fact that the more a 
phthisical person can live out of 
doors the better are his chances for 
recovery. Protectiveclothing should 
always be worn next the skin. A 
daily plunge bath in cool water fol- 
lowed by invigorating friction of the 
skin with a coarse towel conduces 
to free action of the sweat glands 
and assists active elimination. 

Moderate dumb-bell exercise, or 
with chest weights, assists in estab- 
lishing freer circulation. Fatigue 
should not be encouraged in the per- 
formance of these duties, but the pa- 
tient is to be instructed to stop short 



67 
of weariness. Lung development 
should be practiced by drawing in 
air through a quill until the lungs 
are fully inflated, then allowing the 
air to be as gradually expired. 

An important hygienic point in 
the treatment of tuberculous cases 
is proper clothing. A great number 
of consumptives think they must 
clad themselves heavily, especially 
about the chest, and, with this unfor- 
tunate idea, they generally wear two 
or three undershirts of wool, in ad- 
dition to a chest protector. The re- 
sult is that the skin of the chest is 
kept in an unnecessary state of ex- 
cessive perspiration, which renders 
an individual the more susceptible to 
contract numerous "eolds." The 
whole body should be evenly and 
warmly clad; silk and wool flannel 
to be preferred next the skin. Sev- 
erity of weather to an extent de- 
manding excessive weight of cloth- 



68 
ing indicates that a patient should 
seek a warmer clime for a residence. 

Out-of-door life is essential for the 
welfare of phthisical persons. The 
sudden changes in temperature ex- 
perienced by those who live in our 
northern districts, caused not only by 
storms, but by the relation between 
in-door and out-of-door heat, imply 
additional dangers to the contrac- 
tion of "colds." For this reason, if 
for no other, should the consumptive 
live in warm climates where he can 
remain in the open air as much as 
possible. 

Sea voyages are useful in a propor- 
tion of cases. The exposure and out- 
of-door life, necessarily led in a 
long sea trip, are very beneficial. 



69 



MEDICATION. 



Elimination is tlie first principle to 
consider in the medicinal treatment 
of phthisis, and this relates with the 
extent of pathological changes which 
have taken place in a given case. It 
is essential that an obstruction, 
wherever it is, be removed. Elimina- 
tion does not necessarily imply that 
associate excrementory organs must 
be called into excessive activity in 
order that the system may be reliev- 
ed of stagnant waste. The chances 
are that good results from this prac- 
tice will be wanting. Elimination 
must come gradually by judicious 
employment, from time to time, of 
agents which will promote absorp- 
tion of the pathological agent ob- 
structing. Nutritious elements caus- 
ing obstruction by becoming excess 
of waste must be avoided. On the 



70 

other hand, oxidation and organiza- 
tion of new tissue should be encour- 
aged. Cure of tuberculous deposits 
will come by suppuration and absorp- 
tion, and for this reason we need al- 
teratives, because such pathological 
changes exist. 

To a large degree cure can be ac- 
complished by dietetic and climatic 
treatment tending to advance nutri- 
tion. 

One of the most satisfactory meth- 
ods of elimination and alteration 
which have been given the profession 
in late years bearing on this dis- 
ease is a formula advocated by Dr. 
Barclay, of Pittsburg, and consisting 
of the bromide of gold and arsenic. 
Arsenic is a well-known alterative in 
phthisis and highly efficient as a tis- 
sue builder. The late Dr. E. A. Wood 
presented the therapeutic value of 
this formula, in all wasting diseases, 
two years back, in a paper before 
a Western medical association, the 



71 

subject of which was so thoroughly 
circulated about the country that its 
quotation here is unnecessary. Prac- 
tical experience with this formula 
bears out all the claims made for 
it. It is not to be considered as a 
specific for tuberculosis, in any sense 
of the word, but that it is an active 
eliminator and alterator there can 
be no doubt in the minds of those 
who have used it. 

Iodine has long been established 
as useful in the treatment of tuber- 
culous conditions. The syrup of hy- 
driodic acid, as prepared by R. W. 
Gardner, gives the most service- 
able form for internal administra- 
tion, as it is less irritating to the 
stomach. Locally iodine may be ap- 
plied to the lung area by inhalation 
with ether. Dr. Garretson advocates 
a few drops of the compound tincture 
of iodine in equal portion of sulphuric 
ether, to be held in the palm of the 
hand and placed close to the nose, 



72 
when the vapor of the ether inspired 
will carry the iodine to all accessible 
portions of the lung. 

Other alteratives may be employed 
with benefit when indicated. 

Symptomatic medication for pul- 
monary tuberculosis, as with most 
chronic ailments, is directed to a 
variety of complications which arise 
during the course of the disease. For 
the indications in which it is neces- 
sary to employ symptomatic medica- 
tion the physician is to be governed 
by the individual case in hand. As a 
rule, the least medication employed 
is best, attention being directed to 
nutritional and climatic treatment. 

Catarrh of the stomach has been 
mentioned and its treatment indica- 
ted. Catarrh of the nasel passages 
may be efficiently combated by a 
diluted hydrozone spray or Carl Sell- 
er's formula. In acute exacerbations 
of this affection I have seen good 



73 
temporary results from the employ- 
ment of the following formula: 

R. Cocaine hydrochlor. grains vi 

Bismuth subcarb. drachms, ss 
Talc. drachms, iss 

M. thoroughly. 

Sig. Snuff every four hours. 

In chronic catarrh a mild astrin- 
gent powder or boric acid may be 
added to the above. Atomization of 
medications apply to the topical 
treatment of nasal catarrh. Mr. 
Marchand has invented an efficient 
instrument with an attachment for 
applying ozone, made from glycerine 
and peroticle of hydrogen. 

Anorexia, dependent on a catarrh- 
al state of the stomach or the gen- 
eral debility of phthisis, is not to be 
taken as an indication that food is 
not required. This state is often 
overcome by treatment of the stom- 
ach, combined with small but fre- 
quent feedings. Such agents as pro- 



74 
mote digestion, papoid, pepsin, pan- 
creatin and one of the dilute mineral 
acids, aid the assimilation of food in 
this condition and indirectly promote 
appetite. Gaseous eructations call 
for the employment of bismuth in ad- 
dition to the above. 

Attacks of pleuritic pain require 
sinapisms to the chest wall and mor- 
phia. When the latter is used less 
discomfort will be experienced after- 
ward if atropia is combined. 

Fever, unless excessive, rarely re- 
quires treatment. The employment 
of phenacetin often prevents active 
fever and quiets the nervous system 
beside. 

Night-sweats, when excessive, tax 
the patience of the physician, and it 
will be found that no drug can be re- 
lied upon to prevent this disagree- 
able phenomenon in every case. 
Among those holding an efficient po- 
sition are ergot, atropia, aromatic 
sulphuric acid and agaric. 



75 

Cough does not call for active 
treatment. Occasionally, when hard 
and dry, quieting preparations may 
be necessary. Nauseating expecto- 
rants should not be given. Paregoric 
and the preparations of ammonia are 
sometimes beneficial. When cough 
is accompanied with abundant ex- 
pectoration I have seen good results 
from the smoking of pure cubebs; 
the smoke being drawn well into the 
lungs. Even ladies soon become ac- 
customed to the use of this remedy. 

Bronchial hemorrhage requires ac- 
tive treatment. When due to a con- 
gestive state, remedies applicable to 
the lessening of blood pressue are in- 
dicated. If due to ulceration contrac- 
tion of the lumen of blood-vessels 
should be encouraged. During the 
hemorrhage common salt in large 
doses is generally efficient. Ergot, 
or ergotin, hypodermically adminis- 
tered, acetate of lead or tannic acid 
are recommended. Temporary liga- 



76 
tion of a limb is often useful in con- 
trolling hemorrhage. This should 
only be employed during the pres- 
ence of the physician. 

Symptomatic medication, in this 
article, has only been outlined. The 
circumstances of the patient and the 
peculiarity of this disease require 
that the physician be one whose 
sound judgment and educated sense 
is equal to the task of meeting any 
symptomatic indication with the 
most efficient remedy at his com- 
mand. The most hopeless cases to 
treat are among the poor, where pov- 
erty deprives the victim of phthisis 
of the necessaries for even palliative 
treatment. 

The primal thought must be di- 
rected to the restoration of perfect 
elimination, especially in the locali- 
ties obstructed. For this reason the 
consideration of antiseptic medica- 
tion has been omitted, the author 
recognizing the fact that very little 



77 
good has been accomplished through 
this plan of treatment. Certain drugs 
of the antiseptic class have seemed 
beneficial at times, especially to ap- 
petite and digestion. Their action 
may in some degree be attributed to 
stimulation of elimination. 

In cannot confidently be expected 
that any specific will ever be found 
for the cure of this disease. Phthisis 
arises from a combination of condi- 
tions which require a combination 
of therapeutical measures to eradi- 
cate. Good sanitation and cleanli- 
ness are essential for health among 
the well, and much more important 
are these virtues among the sick. 



PUBLISHED BY 



The Medical Publishing Co., 

718 Betz Building, 

PHILADELPHIA. 

1895. 



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